Anastomotic connectors

ABSTRACT

Various anastomotic connectors ( 400 ) for attaching two blood vessels are described, including connectors, which comprise a plurality of clip like elements. In some embodiments, each clip like element comprises a flat medallion section ( 404 ) and a tearable hook section ( 402 ).

RELATED APPLICATIONS

The present application claims priority from and is acontinuation-in-part of PCT application PCT/IL02/00790, filed on Sep.25, 2002, which designates the US, now published in English as WO03/026475. It also claims priority as well as the benefit under 119 (e)of U.S. Ser. No. 60/492,998, filed on Aug. 7, 2003. This application isalso a continuation-in-part of PCT/IL02/00215, filed on Mar. 18, 2002,PCT/IL01/01019, filed on Nov. 4, 2001, PCT/IL01/00903, filed on Sep. 25,2001. The disclosure of all of these applications, which designate theUS and were filed in English, are incorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to anastomotic connectors.

BACKGROUND OF THE INVENTION

Two blood vessels can be connected to form an anastomotic connection inmany methods, including, for example, using surgical clips, usingsutures, and using anastomotic connectors, for example as provided byKaster in U.S. Pat. No. 5,234,447, the disclosure of which isincorporated herein by reference.

SUMMARY OF THE INVENTION

A broad aspect of some embodiments of the invention relates to varioustypes of anastomotic connectors and clips.

An aspect of some embodiments of the invention relates to a one piececlip adapted to form a part of an anastomotic connection, which clip isself locking. Optionally, the clip is pre-stressed so that whenreleased, is closes and locks. Alternatively or additionally, the clipincludes multiple locking positions.

An aspect of some embodiments of the invention relates to a one piececlip adapted to close and release from a delivery system when allowed toclose, by the delivery system.

A broad aspect of some embodiments of the invention relates to lockingtwo part connectors, in which an elongate hook section, having a hook atits end, is pulled through a medallion section and locked to themedallion section at its tip and the rest of the hook section removed,for example by tearing. In an exemplary embodiment of the invention, aplurality of two part connectors are used to complete an anastomosis,with each such connector acting as a clip. One potential advantage ofnot rigidly tying together the connectors is that the vessels of theanastomosis are not constrained by the such tying and are free to find aminimal stress-position and/or motion pattern.

An aspect of some embodiments of the invention relates to locking a twopart anastomosis connector, in which tearing of an extension off of ahook section helps lock the hook section to a medallion section. In anexemplary embodiment of the invention, the tearing causes some parts ofthe hook section to distort and the hook section is configured so thatthe distortion causes a width of one section to be increased relative toa width of a passage in another section. In one example, the passage isnarrowed. Alternatively or additionally, the width of the section isincreased.

An aspect of some embodiments of the invention relates to a two partconnector in which an elongate hook section includes a slot whichengages a matching tab in a medallion section, which medallion sectiontravels along the hook section. In an exemplary embodiment of theinvention, the locking of the medallion section is within the slot.Alternatively or additionally, the locking of the medallion is on theoutside of the hook section.

An aspect of some embodiments of the invention relates to a two partconnector in which the hook section includes elements that move toeffect the locking. Optionally, the medallion is passive with no partsthereof moving or substantially distorting for the locking.Alternatively, the medallion may have moving or distorting parts aswell.

An aspect of some embodiments of the invention relates to a method oflocking a hook section to a medallion where the hook section includes afirst locking mechanism which engages a section of the medallion andwhere the medallion includes a second locking mechanism which engages apart of the hook section.

An aspect of some embodiments of the invention relates to a lockmechanism for a hook section, in which a widened section of the hooksection includes an internal slot to allow the widened section to becompressed when a medallion section travels over it.

An aspect of some embodiments of the invention relates to providing aring attachment on a medallion section. Optionally, the ring attachmentmay be used to increase a size of an aperture meant for a hook section,for example to assist in mounting the medallion on the hook section orto assist removal therefrom. Optionally, the ring attachment is adaptedto be torn off, for example by pulling.

An aspect of some embodiments of the invention relates to a set of clipsections provided as a single connector in which staggered tearing timesare provided. In an exemplary embodiment of the invention, theindividual connectors are designed such that when tearing forces areapplied, not all the connectors feel the forces at the same time. Thus,a smaller force needs to be applied to tear all the connectors. In oneexample, a single ring is used as a backing for all the medallions,However, each hook section has a different distance between the locationwhere it is held by a pulling system and a location where the medallionis locked. The hook sections with the shortest distance, are torn first.Other variations may be provided, for example, different medallions mayhave different thicknesses or different hook sections may have differentelongation properties or mechanical structures, allowing one hooksection to elongate more before it tears, while a less-elongating hooksection is torn before. Alternatively, the pulling system is skewed,pulling on some hook sections before others. The tearing may bedesigned, for example, to tear opposing legs together or serially, or totear the legs in a different order, for example around the connection,possibly only one and possibly more than one leg at a time.

An aspect of some embodiments of the invention relates to an anastomoticconnector in which a plurality of pullers form a part of a ringconnector and pass inside the ring and, once released, pull blood vesseltissue towards the connector, to complete an anastomotic connection.Optionally, the pullers rotate alternatively or additionally toretracting. Optionally, the pullers pierce blood vessel tissue.Alternatively, the pullers do not pierce blood vessel tissue.

In an exemplary embodiment of the invention, the pullers are attached toa connector body via a curved section that describes an arc of greaterthan 270 degrees. Optionally, this curved section is long enough so thatthe pullers can have a considerable motion without exceeding elastic,super-elastic or shape memory properties of the material from which theconnector is made. Optionally, the curved section flattens during thedeployment.

There is thus provided in accordance with an exemplary embodiment of theinvention, a self-locking clip adapted for vascular tissue connection,comprising:

a body;

a sharp extension on one side of the body and adapted to pierce bloodvessel tissue; and

a base on another side of said body, said base adapted to interlock withsaid extension, at least to prevent retraction of said extension fromsaid bas after inserted,

wherein said clip is pre-disposed to assume a closed configuration wheresaid base locks to said extension. Optionally, said extension defines aplurality of locking positions. Alternatively or additionally, said basedefines an aperture adapted to receive said extension. Optionally, saidaperture is adapted to guide said extension to be locked.

In an exemplary embodiment of the invention, said clip is adapted to beused as part of a set of a plurality of clips to complete singleanastomosis connection.

There is also provided in accordance with an exemplary embodiment of theinvention, a clip delivery system, comprising:

a plurality of clips adapted for vascular tissue connection, each clipcomprising:

-   -   a body;    -   a sharp extension on either end of said body,    -   wherein said clip is pre-disposed to form a “C” shape;

an inner tube defining a plurality of slots; and

an outer tube axially movable with respect to said inner tube,

wherein said inner and outer tube define a receptacle for said clip,said clip being released when said outer tube is retracted relative tosaid inner tube and wherein said inner tube defines a slot adjacent saidreceptacle, said slot adapted to receive a bent-back section of abackwards pointing one of said extensions. Optionally, said body definesan aperture and wherein said inner tube defines a matching protrusion tosaid aperture and wherein said body curves when released, such that saidaperture is released from said protrusion.

There is also provided in accordance with an exemplary embodiment of theinvention, a connector clip adapted for vascular tissue connection,comprising:

a hooked element comprising:

-   -   an elongate body;    -   a designated tear location structurally defined at a location        along said body;    -   a hooked tip adapted to pierce a blood vessel; and

a base element adapted to lock to said hooked section at said lockinglocation,

wherein said hooked element is adapted to not tear vascular tissue.Optionally, said hooked tip is adapted to not cut vascular tissue.Alternatively or additionally, said hooked tip has the shape of aneedle. Alternatively or additionally, said hooked tip is manufacturedby cutting and smoothing a planar material.

There is also provided in accordance with an exemplary embodiment of theinvention, a connector clip adapted for vascular tissue connection,comprising:

a hooked element comprising:

-   -   an elongate body;    -   a designated tear location structurally defined at a location        along said body;    -   a designated locking location structurally defined at a location        along said body,    -   a hooked tip adapted to pierce a blood vessel; and

a base element adapted to lock to said hooked section at said lockinglocation,

wherein said designated tearing location is configured to enhance alocking of said locking location. Optionally, said tearing location isconfigured so that tearing causes the bending of at least one part ofsaid hooked element to narrow a passage of a portion of said baseelement within said hooked element. Alternatively or additionally, saidtearing location is configured so that tearing causes the bending of atleast one part of said hooked element to widen a portion of said hookedelement which travels within said base element. Alternatively oradditionally, said tip is adapted to pierce vascular tissue withoutcausing tearing.

There is also provided in accordance with an exemplary embodiment of theinvention, a connector clip adapted for vascular tissue connection,comprising:

a hooked element comprising:

-   -   an elongate body having a slot defined therein;    -   a designated tear location structurally defined at a location        along said body;    -   a designated locking location structurally defined at a location        along said body;    -   a hooked tip adapted to pierce a blood vessel; and

a base element adapted to lock to said hooked section at said lockinglocation and including a section that fits in said slot,

wherein said designated locking location is located in said slot.Optionally, said hooked element comprises a second designated lockinglocation on an outside of said hooked element. Alternatively oradditionally, said tip is adapted to pierce vascular tissue withoutcausing tearing. Alternatively or additionally, said base element isplanar.

There is also provided in accordance with an exemplary embodiment of theinvention, a connector clip adapted for vascular tissue connection,comprising:

a hooked element comprising:

-   -   an elongate body;    -   a designated tear location structurally defined at a location        along said body;    -   a designated locking location structurally defined at a location        along said body;    -   a hooked tip adapted to pierce a blood vessel; and

a base element adapted to lock to said hooked section at said lockinglocation,

wherein said designated locking location is defined by at least oneactive portion on said hooked element which engages a portion of saidbase section. Optionally, said base element includes no portions thatmove relative to a center of gravity of said base element during alocking activity. Optionally, said base element is planar.

In an exemplary embodiment of the invention, said tip is adapted topierce vascular tissue without causing tearing.

There is also provided in accordance with an exemplary embodiment of theinvention, a connector clip adapted for vascular tissue connection,comprising:

a hooked element comprising:

-   -   an elongate body;    -   a designated tear location structurally defined at a location        along said body;    -   a designated locking location structurally defined at a location        along said body;    -   a hooked tip adapted to pierce a blood vessel; and

a base element defining a second locking location adapted to lock tosaid hooked element, wherein both said base element and hooked elementeach include at least one portion that moves during locking.

There is also provided in accordance with an exemplary embodiment of theinvention, a connector clip adapted for vascular tissue connection,comprising:

a hooked element comprising:

-   -   an elongate body having an axis;    -   a designated locking location structurally defined at a location        along said body;    -   a hooked tip adapted to pierce a blood vessel; and

a base element having an aperture adapted to ride on said body, saidbase element adapted to lock to said hooked element at said designatedlocking location,

wherein said locking location comprises at least one widening on saidhooked element perpendicular to said axis and at least one apertureformed in said body adjacent said widening.

There is also provided in accordance with an exemplary embodiment of theinvention, a connector clip adapted for vascular tissue connection,comprising:

a hooked element comprising:

-   -   an elongate body having an axis;    -   a hooked tip adapted to pierce a blood vessel; and

a base element having an aperture adapted to ride on said body andwherein at least one section of said base element contacting saidaperture is adapted to be elastically moved to widen said aperture andcomprising:

-   -   at least one holder adapted to widen said aperture when pulled        against a resistance of said hooked element in said aperture.        Optionally, said holder comprises an apertured holder.        Optionally, said aperture contains a thread.

In an exemplary embodiment of the invention, said holder is adapted tobe torn off said base element.

There is also provided in accordance with an exemplary embodiment of theinvention, a method of mounting a base element of an anastomotic clip ona hooked element of an anastomotic clip, comprising:

placing said hooked element in an aperture of said base element; and

pulling on a holder section of said base element to widen said aperture.

There is also provided in accordance with an exemplary embodiment of theinvention, a method of demounting a base element of an anastomotic clipon a hooked element of an anastomotic clip, comprising:

pulling on a holder section of said base element to widen an aperture ofsaid base element on which said hooked element is mounted; and

removing said base element.

There is also provided in accordance with an exemplary embodiment of theinvention, a connector clip set adapted for performing a vascularanastomotic connection, comprising:

a plurality of connector clips, each comprising:

-   -   a hooked element comprising:        -   an elongate body having an axis, a first end and a second            end;        -   a pulling point adapted to have a pulling force applied to            at said first end        -   a hooked tip adapted to pierce a blood vessel at said second            end        -   a resting point for a base element between said ends; and    -   a base element adapted to ride on said body and stop at said        resting point,

wherein a distance between said resting point and said pulling point isdifferent for different ones of said clips. Optionally, said restingpoint is adapted to withstand a force of at least 1 Kg applied from saidpulling point.

There is also provided in accordance with an exemplary embodiment of theinvention, a pulling connector adapted for vascular tissue connection,comprising:

a ring; and

a plurality of hooked elements having an elongate body and curved intosaid ring,

wherein said elongate elements are pre-disposed to retract such thatthey pull vascular tissue towards said ring to complete an anastomoticconnection. Optionally, said hooked elements rotate when released.Alternatively or additionally, said curves flatten when released.

In an exemplary embodiment of the invention, said hooked elements areadapted to pierce blood vessel tissue without tearing.

In an exemplary embodiment of the invention, said ring defines aplurality of recesses for said hooked elements.

In an exemplary embodiment of the invention, said ring is substantiallyrigid.

There is also provided in accordance with an exemplary embodiment of theinvention, a method of deploying a tearing vascular anastomoticconnector having multiple tearing points, comprising:

tearing a first leg to complete a first part of an anastomosis; and

tearing a second leg after said first tearing to complete a second partof said anastomosis. Optionally, the method comprises applying acontinuous force to said connector during said first and second tearingand in between.

BRIEF DESCRIPTION OF THE FIGURES

Non-limiting embodiments of the invention will be described withreference to the following description of exemplary embodiments, inconjunction with the figures. The figures are generally not shown toscale and any sizes are only meant to be exemplary and not necessarilylimiting. In the figures, identical structures, elements or parts thatappear in more than one figure are preferably labeled with a same orsimilar number in all the figures in which they appear, in which:

FIG. 1A is a perspective view of a closed self-locking clip, inaccordance with an exemplary embodiment of the invention;

FIG. 1B is a side-cross-sectional view of a deployed clip forming a partof an anastomotic connection, in accordance with an exemplary embodimentof the invention;

FIGS. 2A-2C illustrate a process of using the clip of FIG. 1, inaccordance with an exemplary embodiment of the invention;

FIG. 3 illustrates a delivery system for deploying a plurality ofself-releasing clips, in accordance with an exemplary embodiment of theinvention;

FIGS. 4A and 4B show plan views of a hook section of a hook-medallionconnector, in accordance with an exemplary embodiment of the invention;

FIG. 4C shows a deployed hook-medallion connector, in accordance with anexemplary embodiment of the invention;

FIG. 4D shows a plurality of hook and medallion connectors, duringdeployment, in accordance with an exemplary embodiment of the invention;

FIGS. 5A and 5B show alternative forward parts of hook sections, inaccordance with exemplary embodiments of the invention;

FIGS. 6A-6D show embodiments of hook sections with inner slots, inaccordance with exemplary embodiments of the invention;

FIG. 6E shows a medallion section suitable for riding on a hook sectionof FIGS. 6A-6D, in accordance with an exemplary embodiment of theinvention;

FIGS. 7A-7D show embodiments of medallion sections that ride on a slotof a hook section, in accordance with exemplary embodiments of theinvention;

FIGS. 8A-8E show embodiments of medallions sections having locking to ahook section by one or more tabs of the medallion engaging the hooksection from its front and/or back side, in accordance with exemplaryembodiments of the invention;

FIGS. 9A-9C show medallions in which locking tabs lock into aperturesdefined in a side of a hook section, in accordance with an exemplaryembodiment of the invention; and

FIGS. 10A-10E illustrate a puller connector and its use, in accordancewith an exemplary embodiment of the invention.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

Self Locking Clip

FIG. 1A is a perspective view of a closed self-locking clip 100, inaccordance with an exemplary embodiment of the invention. FIG. 1B is aside-cross-sectional view of a deployed clip 100. Clip 100 comprises anextension 102 having a sharp point 103, that is adapted to pass througha target vessel 120, in a minimally-traumatic manner and pass through anaperture 106 in a base section 104 of clip 100. Optionally oradditionally, aperture 106 defines one or more engagement areas 112and/or extension 102 defines one or more engagement areas 108, such thatclip 100 can lock, at least to prevent retraction of tip 103, in one ormore locking positions.

In an exemplary embodiment of the invention, aperture 106 comprises awide section marked with reference number 106 and a narrow section 110where locking occurs. Optionally, the wider aperture section serves todefine a part of base 104 as a spring section which is pre-disposed tooppose widening of slot 110. Optionally, slot 110 continues into a bodysection 107 of clip 100, that connect the base and extension sections ofclip 100.

FIG. 1B is a cross-sectional view showing only one wall of a graftvessel 122 and part of a wall of aorta 120. FIG. 1B shows a particulareversion of graft vessel 122 on clip 100. However, in other embodiments,graft 122 need not be everted and may be, for example, transfixed onextension 102. The position of graft 122 relative to body 107 isoptionally determined by an optional tissue stop 118. If no such tissuestop is provided and body 107 is narrow, then graft 122 may, forexample, lie entirely outside of vessel 120.

A potential advantage of not having a tissue stop, which advantage maybe practiced in other embodiments described herein if a tissue stop isnot used, is that the force that a physician applies on the graft vesselcan cause the vessel to selectively slide up. For example, if an obliqueconnection is desired, pulling the vessel into position may cause thevessel parts mounted on clips in the oblique angled section of theanastomosis to slide up, while vessel parts on the acute angled sectionswill not slide up. Such forces may be applied, for example, during theanastomosis or after it is completed.

FIGS. 2A-2C illustrate a process of deploying clip 100, in accordancewith an exemplary embodiment of the invention. While a plurality ofclips are generally used, for clarity, only a single clip is shown.

In FIG. 2A, only a tip 103 of clip 100 protrudes from a delivery system200. As will be clearer in the following figures, in an exemplaryembodiment of the invention, clip 100 is held between an outer tube(visible) 202 and a mostly hidden inner tube 204. In an exemplaryembodiment of the invention, a graft vessel is provided through deliverysystem 200, so that it exits via an aperture 206 at its end.

In an exemplary embodiment of the invention, the configuration of FIG.2A is used for eversion, with a graft (not shown) being everted overtube 202 and, in the process, being transfixed by tips 103. It should benoted that even though clip 100 has a tendency (elastic, super elasticor shape memory, for example) to achieve the geometry of FIG. 2A,extension 108 is mostly straight, so that tip 103 does not bend awayfrom the axis of tube 202.

In FIG. 2B, inner tube 204 is advanced, so that all of extension 102 isadvanced forward and released from between tubes 202 and 204 andtherefore, curves backwards. In an exemplary embodiment of theinvention, this configuration is used for engaging a target vessel, forexample an aorta. Delivery system 200 is placed into an aperture in theblood vessel, for example in the configuration of FIG. 2A, and extension102 is released. Delivery system 200 is then pulled back, so that tip103 engages the target vessel from inside. This step is consideredcomplete when all of tips 103, of all the clips used are seen toprotrude from the outside wall of the blood vessel. Alternatively,delivery system 200 may be inserted into the target vessel when alreadyin the configuration of FIG. 2B, as there are no forward pointing sharppoints or elements to interfere with such motion.

In FIG. 2C, tube 202 is further retracted, so that base section 104 ofclip 100 is released and can lock to extension 102. A property ofaperture 106 in accordance with some embodiments of the invention can besee, that aperture 106 is inclined so that if extension 102 lands in awide section thereof and is pre-stressed to close towards body 107, thesides of aperture 106 will guide such closing.

Also visible in FIG. 2C is a mechanism for holding clips 100, in which aplurality of raised areas 210 define a plurality of recesses 208 betweenthem. Each recess having the depth of the thickness of one clip andadapted to contain one clip. When tube 202 lies over tube 204, the clipsare prevented from returning to their closed shape, except as they arereleased.

Self Releasing Clip

FIG. 3 illustrates a delivery system 300 for deploying a plurality ofself-releasing clips 320, in accordance with an exemplary embodiment ofthe invention. Clips 320 are two sided clips having a body 322 with oneextension on either end, 324 and 326. When released, as shown, the clipsclose to form a “C” shape. The deployment process can be as in FIGS.2A-2C.

An exemplary delivery system 300 is shown, in which clips 320 are heldbetween an inner tube 304 and an outer tube 302. In an exemplaryembodiment of the invention, clips 320 are each maintained in an axialposition by a projection 310 of inner tube 304, which fits into a recessor aperture 328 of clip 320. Optionally, when clip 320 is released, body322 curves, curving aperture 328, thereby allowing projections 310 toslide by clips 320.

It should be noted that unlike clip 100, clip 320 has two curvedextensions. In an exemplary embodiment of the invention, a plurality ofslots 312 are provided in tube 304, so that extension 324 can be bendall the way back without distorting the clip in a manner which preventsdeployment to the correct shape. In one example, when held by deliverysystem 300, the tip of extension 324 contacts the inner wall of tube302, extension 324 is bent into slot 312 and the rest of clip 320 liesflat or is curved as does clip 100, in FIGS. 2A and 2B respectively.Optionally, tube 302 is coated on the inside with a softer material,such as a plastic, so that the point of extension 324, if made of metal,is not blunted.

Medallion and Hook Connector

FIGS. 4A and 4B show a hook section 402 of a hook-medallion connector,in accordance with an exemplary embodiment of the invention. FIG. 4Cshows a deployed hook-medallion connector 400, in accordance with anexemplary embodiment of the invention. FIG. 4D shows a set of connectorsduring deployment, prior to tearing thereof.

In a typically anastomosis, a plurality of hook-medallion connectors 400are used, surrounding the anastomosis location. Each connector 400comprises a hook section 402 and a medallion section 404. Whendeploying, a forward section 406 of hook section 402 engages and locksto medallion section 404 and the rest of hook section 402 is torn offand removed from the body.

Deployment may be similar, for example to that of FIGS. 2A-2C, exceptthat instead of releasing a back section, hook sections 402 areretracted until they lock and tear. An exemplary delivery system isdescribed in PCT publication WO 03/026475, the disclosure of which isincorporated herein by reference. After deployment, the connectors maybe independent of each other, or be attached, for example by thin wiresor sutures.

Referring in greater detail to FIG. 4A, hook section 402 comprises abody 410 having a slot 412 defined at one end thereof, and a tissueengaging tip 414 defined at another end thereof. Slot 412 is provided asan anchoring point for an engager (not shown) which retracts hooksection 402 with sufficient force to tear it off of forward section 406.Tissue engaging tip 414 is shown as flat, however, when deployed, it iscurved into a hook shape, as shown in FIG. 4C, for example. In anexemplary embodiment of the invention, the hook shape is configured sothat it is about at the level of the plane of medallion 404, for exampleslightly below or slightly above. The exact position may depend on theamount of tissue trapped therein.

Referring in greater detail to FIG. 4B, forward section 106 comprisestip 414 and a tissue engaging section 420. Optionally, one or moretissue stops (e.g., increased width sections) are provided to controlthe slippage of tissue with respect to section 420. These stops are notshow but may be positioned, for example between tip 414 and stop 424,described below. A locking area 426 is provided for locking to medallionsection 404. One or more stop tabs 424 are provided to prevent forwardmotion of medallion 404. Optionally, tabs 424 are made strong enough towithstand the forces of tearing without substantial distortion, forexample, forces of 1, 2.5, 5, 10, 20, 25 or more Kg. One or more backtabs 428 are provided to prevent medallion 404 from falling off of hooksection 402. As shown, back tabs 428 are inclined in the forwarddirection and step-like in the backward direction. Optionally, thestep-like structure makes reverse passage of medallion 404 difficult,while the inclined structure makes it easier. In an exemplary embodimentof the invention, a slot 436 is provided between tabs 428, so that thematerial of tabs 428 can be pressed into slot 436 while medallion 404 ispassed over it One or more slots 432 are provided behind tabs 428, todefine weakened areas 434, for tearing. Slot 436 optionally extendsbetween two such weakened areas.

In an exemplary embodiment of the invention, slots 432 and weakenedareas 434 are configured so that tearing forces will tend to cause tabs428 to bend out rather than in. In the example shown, cut-out section430 is provided to assist in such bending. The tearing action willgenerally first elongate and then tear. In the configuration shown, thiswill tend to cause tabs 428 to bend away from slot 436.

In an exemplary embodiment of the invention, tip 414 is manufactured sothat it does not tear vascular tissue. While tip 414 may be made from aplanar material, In an exemplary embodiment of the invention, it issmoothed, for example using electro-polish so that the only sharpsection thereof is its needle like tip. Thus, it will tend to not tearvascular tissue when inserted thereto.

Referring in greater details to FIG. 4C, medallion section 404 comprisesa ring section 440 through which tissue and tip 414 pass and a lockingsection 441 including an aperture 442 which rides on hook section 402.In the embodiment shown, aperture 442 is slightly undersized to receivehook section 402 and is thus elastically predisposed to engage hooksection 402. In the embodiment shown, aperture 442 includes does notcompletely encircle hook section 402, an opening 450 is provided.Optionally, this allows a greater degree of movement for a pair of backtabs 448 which press against a back side of hook section 402. One ormore removed sections 446 may be provided adjacent tabs 448, to definedesired elastic properties of tabs 448. In general it should be notedthat as a section is made thicker, a greater force is required toelastically deform it. Further, depending on the geometry of thesection, a certain force may cause permanent distortion. Generally,sections that are longer have a greater distance they can be distortedelastically. In an exemplary embodiment of the invention, variousremoved sections are provided to control elastic forces and amount ofmovement without distortion, for example, a pair of removed sections 444are provided adjacent a tab 452 on a front side of aperture 442. Theremoved sections sizes may be the same or may be different, depending,for example, on the desired properties. It should be noted that while asymmetric medallion is shown, an asymmetric design can be used as well.In an exemplary embodiment of the invention, medallion section 404 issubstantially passive in that during locking and/or sliding, no parts ofthe medallion move relative to the center of gravity of the medallion.Optionally, any elastic ability of the medallion is to provide someleeway while mounting it on the hook sections or for applying a constantforce against the hook section.

FIG. 4D shows a cross-sectional view of an exemplary anastomoticconnection, after locking and prior to tearing.

The forces applied during tearing can be quite large, for example, 2.5Kg per hook section, if all the hook sections are torn together, thismight require a robust delivery system and/or cause movement by theuser. In an exemplary embodiment of the invention, a connector set foran anastomosis is provided in which not all hooks are designed to beartearing forces at a same time, thus a smaller force can be applied.Alternatively or additionally, the hook tearing may be staggered forother reasons, such as the ability to connect one side of theanastomosis first, for example for an oblique connection.

In some embodiments of the invention, the delivery system is designed tobear first on some hook sections and then on others. Alternatively, thehooks sections and/or medallion sections are designed to achieve adesired effect. In an exemplary embodiment of the invention, a set ofconnectors, for example arranged in a delivery systems is provided inwhich each hook has a desired relative tearing time.

In an exemplary embodiment of the invention, the distance between stop424 and slot 412 is different for different hooks. The hooks with ashorter distance will feel a tearing force applied between those twopoints, first. Alternatively, slot 412 is made of different lengths fordifferent hooks. Alternatively or additionally, different thicknessmedallions are provided. Alternatively or additionally, differentelongation properties for different hook section are provided, forexample, a bent ribbon section may be provided in one hook section toallow its greater elongation. Alternatively, chemical, mechanical and/orheat treatments are used to vary elongation.

Hook Section Variations

As can be appreciated, many variations on hook section 402 can beprovided within the scope of the invention. for example, FIGS. 5A and 5Bshow alternative forward parts of hook sections, in accordance withexemplary embodiments of the invention. FIG. 5A shows an embodimentwhere a slot 536 underlies a locking area 526 as well as back lockingtabs 528. Also, in this embodiment, a weakened area 534 is defined bycut outs on one or both sides, such as a widening of slot 536 and/or anarrowing of the body of the hook section from outside. Optionally, thepart of slot 536 underlying locking area 526 is used for an innerlocking of the medallion section, provided by a tab of the medallionsection entering slot 536. Example medallions with a tab that locks to aslot underlying a locking area are described below. Alternatively oradditionally, the elongated slot 536 increases the flexibility of backlocking tabs 528. An elongated slot, however, may cause leakage of bloodalong the slot.

FIG. 5B shows a variation in which a slot 586 serves only to define apair of weakened areas 584. This is an extreme example of aflexibility/sealing tradeoff, in that there will be no leakage when theslot is not in the blood vessel.

In another variation (not shown) a portion of the hook section isadapted to bend out of the plane of the hook and thus create aneffective thickening of the hook. Such a thickening can also preventreverse movement of the medallion on the hook.

Inner Slot Engagement

In FIGS. 4A-5B, the medallion section slides along the outside of thehook section. In some alternative embodiments, the medallion section atleast engages a slot defined on the inside of the hook section

FIGS. 6A-6D show embodiments of hook sections with inner slots, inaccordance with exemplary embodiments of the invention. FIG. 6E shows amedallion section suitable for riding on a hook section of FIGS. 6A-6D,in accordance with an exemplary embodiment of the invention.

Referring to FIG. 6A, a hook section 602 includes a body 610 with aforward section 606 shown in more detail in FIG. 6B. An optional backslot 612 is provided for engagement by a puller. Alternatively, adifferent structure, such as a “T” shaped end, may be used. A slot 637for a medallion is provided along body 610 and into forward section 606.

Referring to FIG. 6B, forward section 606 has only inner lockingmechanisms. Locking of a tab section of the medallion is provided in alocking area 625 which is a continuation of slot 637. One or more innerbackwards tabs 629 are inclined so that forward motion along slot 637 ispossible, while backwards motion once locking area 625 is reached, isdifficult or impossible. Weakened areas 634 are optionally weakened bythe provision of weakening apertures 632. It should be noted that inthis and other embodiments, other methods of weakening may be used, forexample, thinning, aperture forming, heat or chemical treatment and/ormechanical treatment.

While locking area 625 may have a length equal to the thickness of amedallion section, optionally, a greater length is provided, for exampleto allow the medallion some freedom of rotation and/or motion.

FIG. 6C shows a variant forward section 660, in which an externaladvancement stop 664 is provided to stop forward movement of themedallion and/or to stop advancement of tissue along section 660. A pairof inside backwards locking tabs 669 are shown for stopping reversemovement of a medallion out of a locking area 665. Optionally, theinclined nature of advancement stops 664 serves the purpose of providingan elastic stop whereby if the force applied to the medallion issufficient, a small advancement is possible.

A pair of weakened areas 674 are defined by a widening 672 in slot 677.It should be noted that when tearing weakened areas 674, locking tabs669 will tend to bend inwards.

In the particular embodiment shown, slot 677 is narrower than slot 665.In other embodiments, they may be the same width or slot 677 may bewider. Optionally, for example as will be shown below for some designsof medallions, a first tab section of the medallion rides in slot 677and when slot 677 widens into slot 665, additional tab sections of themedallion enter slot 665. Optionally, for some medallion designs, noparts of the medallion are ever inside slot 677, except for locking area665, when locking occurs.

Another difference which can be noted between section 606 and section660, is that a body 620 of FIG. 6B is thinner than a body 678 of FIG.6C. This variation may depend, for example, on the robustness of theblood vessels being attached and/or the size of the anastomosis.

FIG. 6D shows a forward section variation 680, in which a locking area686 is defined between at least one forward outside tab 684 and at leastone backward outside tab 688. A weakened area 694 is defined by aweakening aperture 692. Optionally, a slot 697 continues (not shown)adjacent locking area 686, thereby providing an inner locking area.Alternatively, in the embodiment shown, a section of the medallion staysin slot 697, against an end 698 thereof. Alternatively, slot 697 is usedfor the tearing mechanisms. As can be appreciated, the forces appliedduring tearing are considerable and might conceivably damage theconnector. In an exemplary embodiment of the invention, tearing forcesare not applied to the medallion or to locking area 686. Instead, a tabof the deliver system rides in slot 697. Tearing is achieved by pullingback on the hook connector from its far end (e.g., 612, FIG. 6A) whilemaintaining the tab in place against end 698.

FIG. 6E shows a medallion 640 including a tab section 650 which can ridealong a slot in a hook section, such as slot 637. While a ring section640 is shown, it should be noted that in some applications this ringsection can be replaced by a sharp extension adapted to impale tissue,for example, an extension of tab 650 bent into the figure plane towardsthe tip of the hook section. More examples of such a design and otherclips designs are provided in a PCT application filed by a sameapplicant “By-Pass inc.”, in the Israel receiving office, on same dateas the instant application, having a title of “Sliding Surgical Clip”and having an attorney docket number of 088/03506, the disclosure ofwhich is incorporated herein by reference. Furthermore, while a lockingsection 641 is shown, in some embodiments of the invention, this sectionis dispensed with and riding and locking are provided by tab 650. In theembodiment shown, however, a pair of optional forward locking tabs 648are shown which urge against parts of the hook section that ride in anarea 642 adjacent tabs 648. Alternatively or additionally, backwardstabs 652 are provided for a similar function. Locking area 641optionally functions as an elastic spring to urge the tabs against thehook section, optionally into apertures or cut-outs defined in the hooksection for that purpose.

Slot Riding Medallion Variations

FIGS. 7A-7D shows embodiments of medallion sections that ride on a slotof a hook section, in accordance with exemplary embodiments of theinvention;

FIG. 7A shows a medallion 700, in which a tab 702 is adapted to rideinside slot 337, for example. One or more front tabs 704 are optionallyprovided to urge against the hook section, optionally locking intoapertures of the hook section. A ring section 706 optionally also servesas a spring for tabs 704. An alternative locking mechanism is that walls703 on either side of tab 702 engage a locking area such as area 686.

FIG. 7B shows a medallion 720, in which a tab riding section 722includes a mushroom extension 723, to prevent it from slipping off slot637. A pair of side tabs 728 are provided to apply force from the sidesof the hook section. Ring 726 optionally provides tabs 728 with someelasticity. Medallion 720 is optionally mounted by distorting extension723 during mounting.

FIG. 7C shows a medallion 740, which has no ring. Side and/or forwardpressure on the hook section are provided by extension sections 744(forward) and 748 (side), which receive their elasticity from a springsection 750.

FIG. 7D shows a medallion 760 similar to medallion 740 of FIG. 7C,including a ring section 766. In an alternative embodiment, a mushroomsection 763 of a riding tab 762 is extended to act as a ring section(e.g., to receive the tip of the hook section and/or to serve as a stopto prevent tissue motion).

Front and/or Back Locking Medallion Variations

FIGS. 8A-8E show embodiments of medallions with means for locking to ahook section by one or more tabs of the medallion engaging the hooksection from its front and/or back side, in accordance with exemplaryembodiments of the invention.

FIG. 8A shows a medallion 800, in which a hook section fits in anaperture 802 thereof. When the hook section is to be locked, an apertureof the hook section is moved to be adjacent a forward locking tab 804 ofmedallion 800 and is urged into the aperture of the hook, by virtue ofthe original width of aperture 802 being smaller than a thickness of thehook. A spring section 808 optionally provides elasticity for thisurging. An optional ring section 806, is shown as well.

FIG. 8B shows an alternative medallion 820, in which both a forwardlocking tab 824 and a backwards locking tab 825 are provided projectinginto an aperture 822 for the hook section. In the embodiment shown, aspring 828 is provided only for backwards locking tab 825. Alternativelyor additionally, a spring is provided for tab 824.

FIG. 8C shows an alternative medallion 840, in which a forward lockingtab 844 and a backwards locking tab 845 are provided projecting into ahook aperture 842. One or both the tabs may be optional, for example, ifthe hook section includes a locking tab. An optional side section 849optionally defines the width of aperture 842. Optionally, section 849 iselastically urged into aperture 842. Optionally, a pull-ring 850 isprovided, which can be used to open aperture 842 by pulling on a spring848 which advances tab 845 into aperture 842. Optionally, pull ring 850is used during mounting, to widen the aperture. Alternatively oradditionally, pull ring 850 is used to suture the medallions together. Aweaken section 852 is optionally provided to assist in removing pullring 852, for example by bending or by tearing.

While a closed ring section 846 is shown, in other embodiments, the ringsection is open, for example defining to fingers or arcs away fromaperture 842.

FIG. 8D shows an alternative medallion 860, in which only a backwardslocking tab 865 is provided. Optionally, however, a slot 874 is providedin a body ring 866, which slot enables ring 866 to provide elasticityfor two side tabs 869 that engage the hook section from the sides.Optionally one or more side horns 876 are provided near tab 865, toprevent over advancing of tab 865 into the hook section. Alternativelyor additionally, such circular cutouts are provided as part of a cuttingdesign process which takes a minimum cutting radius into account,especially when there is a need for straight lines.

In this variation, a pull-ring section 870 is ellipsoid rather thanround.

FIG. 8E shows an alternative medallion 880, in which a forward lockingtab 884 is long enough to completely pass through a matching aperture inthe hook section. A pair of tabs 889 is optionally provided to urge thehook section onto tab 884. Due to the large distance of motion, in anexemplary embodiment of the invention, a pair of long springs 888 areprovided, which attach to the far side of a ring section 886.Optionally, tab 884 extends from ring section 886.

Side Aperture Medallion

In some embodiments of the invention, locking is provided by a tab ofthe medallion fitting into a narrowing of the hook section. Connector400 is an example of this mechanism, in which the “narrowing” is made byproviding a widening on either side of the locking area. In alternativeembodiments, the width of the hook section is relatively except for anarrowing section. While in connector 400, the medallion section was notrequired to cooperate, In the embodiments of FIG. 9A-9C, the medallionactively urges tabs into a narrowing (relative or absolute) of the hooksection.

FIG. 9A shows a medallion 900 in which a pair of side locking tabs 912lock into apertures or notches (e.g., a narrowing) defined in a side ofa hook section, in accordance with an exemplary embodiment of theinvention. A pair of springs 908 are adapted to urge tabs 912 towards anaperture 902 where the hook section rides. Optionally, springs 908 allowtabs 912 to be moved sideways as well as forwards and backwards. Thisallows the dimensions of aperture 902 to be limited by tabs 912, evenbefore locking. Optionally, a ring section 906 provides some sidewayselasticity, which sideways motion is made possible by a slot 910separating springs 908 from each other.

FIG. 9B shows an alternative medallion 920, in which an aperture 902 forthe hook section is defined on either side by a side tab 932, by a fronttab 924 and by a back tab 925. Optionally, back tab 925 is elasticallyurged into aperture 922 by a spring 927. Alternatively or additionally,front tab 924 is elastically urged into aperture 922 by a spring 929.Alternatively or additionally, locking is provided by side tabs 932,which are mounted on springs 928, attached to ring 926.

FIG. 9C shows an alternative medallion 940 similar to that of FIG. 9B,in which a pair of springs 947 that urge a backwards tab 945 into anaperture 942 are more pronounced. Similarly, a pair of springs 949 whichurge a front tab 944 into aperture 942 are also more pronounced. In thisembodiment, the increased prominence of the springs comprises increasedlength caused by additional bends, which allow for more elastic motion.

Puller Connector

FIGS. 10A-10E illustrate a puller connector 1000 and its use, inaccordance with an exemplary embodiment of the invention. FIGS. 10A and10B show connector 100 in pre-deployed and post-deployed configurations,with no blood vessels attached. In an exemplary embodiment of theinvention, connector 1000 is pre-stressed to go from one configurationto the other, for example, being elastic, super elastic or shape memory.Alternatively, it may be plastically deformed to pass betweenconfigurations, for example by pulling on looped body sections 1006,described below.

Connector 1000 comprises a ring 1002 to which are attached a pluralityof pullers 1004. In an exemplary embodiment of the invention, pullers1004 have looped bodies 1006 with forward sections 1008 which extendinto ring 1002. Forward sections 1008 optionally comprise hooked ends1010, which may be, for example, adapted to pierce blood vessel tissuewith minimum trauma and/or tearing. Alternatively or additionally, atleast some of ends 1010 are adapted to not pierce blood vessel tissue,for example being flattened. Alternatively or additionally, at leastsome of ends 1010 are adapted to pierce tissue only a certain distance,for example by being forked and/or by including tissue stops (not shown)which widen ends 1010.

Optionally a recess 1012 is provided in ring 1002 to receive hook 1010when puller 1004 is retracted. As shown, the recess is approximately thewidth of hook 1010. Alternatively, it may be wider, for example toprevent pinching of tissue between hook 1010 and recess 1012.

FIG. 10B shows connector 1000 with pullers 1004 retracted. In anexemplary embodiment of the invention, the length and shape of pullers1004 allows a relatively long pulling motion to be provided on connector1000 itself, without requiring a specialized delivery system beyond thatrequired for releasing connector 1000 to pull on pullers 1004.Alternatively or additionally, the shape of pullers 1004 allows arotational movement to be carried out by hooks 1010. Optionally, a ring1002 is not provided and is either dispensed with or provided as part ofthe delivery system. In this case, the base sections of pullers 1004 areoptionally made wide, so that they apply force to a relatively largesection of the blood vessel with which it is in contact. Alternatively,ring 1002 is made radially expandable, for example, using expandablecell sections between adjacent pullers.

It should be noted that FIG. 10B shows hooks 1010 lying inside ofrecesses 1012. However, if recesses 1012 are not wider than shown, theexistence of vascular tissue between hook 1010 and recesses 1012 mayprevent such a configuration. Alternatively, if hooks 1010 pierce thevascular tissue, such configuration, as shown, is possible, with all ofthe vascular tissue lying within ring 1002.

FIGS. 10C-10E show the deployment of connector 1000, in one designvariation thereof, where the pullers are not substantially rotated bythe pulling. In some cases, the hooks rotate, for example, 10 degrees,30 degrees, 50 degrees or any intermediate or large amount of rotation.

In FIG. 10C, a graft vessel 1040 is everted and mounted on hooks 1010and hooks 1010 are inserted into a target vessel 1042. The deliverysystem is optionally retracted to engage target vessel 1042 by hooks1010.

In FIG. 10D, hooks 1010 have retracted sufficiently to pierce targetvessel 1042 and to push vessel 1040 hard enough against ring 1002 sothat graft vessel 1040 is also pierced by hooks 1010 (a second time). ifthe everted section of graft vessel 1040 is short enough, no secondpiercing will occur.

FIG. 10E shows an optional further retraction configuration, in whichhooks 1010 pass through recesses 1012 (not shown) in ring 1002.

The following documents, the disclosures of which are incorporatedherein by reference describe connectors, delivery systems and/or othertools and methods which are useful in conjunction with embodiments ofthe prevent invention:

PCT/IL02/00790, filed on Sep. 25, 2002, now published as WO 03/026475;

U.S. Ser. No. 60/492,998 filed on Aug. 7, 2003.

PCT/IL02/00215, filed on Mar. 18, 2002, now published as WO 02/074188;

PCT/IL01/01019, filed on Nov. 4, 2001, now published as WO 02/47532;

PCT/IL01/00903, filed on Sep. 25, 2001 now published as WO 02/30172;

PCT/IL01/00600, filed on Jun. 28, 2001, now published as WO 02/47561;

PCT/IL01/00267, filed on Mar. 20, 2001, now published as WO 01/70091;

PCT/IL01/00266, filed on Mar. 20, 2001, now published as WO 01/70090;

PCT/IL01/00074, filed on Jan. 25, 2001, now published as WO 01/0119;

PCT/IL01/00069, filed on Jan. 24, 2001, now published as WO 01/70118;

PCT/IL00/00611, filed on Sep. 28, 2000, now published as WO 01/41624;

PCT/IL00/00609, filed on Sep. 28, 2000, now published as WO 01/41623,

PCT/IB00/00310, filed on Mar. 20, 2000, now published as WO 00/56228;

PCT/IB00/00302, filed on Mar. 20, 2000, now published as WO 00/56227;

PCT/IL99/00674, filed on Dec. 9, 1999, now published as WO 00/56223;

PCT/IL99/00670, filed on Dec. 8, 1999, now published as WO 00/56226;

PCT/IL99/00285, filed on May 30, 1999, now published as WO 99/62408; and

PCT/IL99/00284, filed on May 30, 1999, now published as WO 99/62415. Thedisclosure of all of these applications, which designate the US and werefiled in English, are incorporated herein by reference.

In addition, a PCT application filed on same date with the presentapplication, by applicant “By-Pass Inc.”, and describing anastomoticconnectors is “Sliding Surgical Clip”, attorney docket number 088/03506,the disclosure of which is incorporated herein by reference. A PCTapplication filed on same date with the present application, byapplicant “By-Pass Inc.”, and describing leg arranging systems is“Anastomotic Leg Arrangement”, attorney docket number 088/03504, thedisclosure of which is incorporated herein by reference.

A provisional application filed on even date with the instantapplication, by applicants Loshakove, et. al and having attorney docketnumber 088/03695 and title “Bypass Punch Anastomosis Delivery System” isalso incorporated herein by reference and describes an exemplarydelivery system.

A clip or a connector may be manufactured of various materials,including for example, metals (e.g., stainless steel, NiTi alloys andtitanium), plastics and bio-absorbable materials. Optionally, the clipis formed of a material that exhibits elastic, super elastic and/orshape memory properties.

Some of these applications describe anastomosis delivery systems andhole making apparatus and/or other device useful in cooperation with thepresent invention. Some of these applications describe delivery systemsin which separate steps are provided for retracting and tearing, andeven, in some embodiments, for advancement of medallion sections.

The above described clips and connectors and their use may be varied inmany ways. For example, the hook sections and/or the medallions may beinterconnected before or after the anastomosis, for example, using aflexible element, such as a suture, or a rigid element, such as a metalbar.

In an exemplary embodiment of the invention, the tips that are designedto penetrate blood vessel tissue are sharpened to minimize trauma to theblood vessels, during attaching, and especially to reduce tearing and/ordissection. For example, the tips may be formed to be needle like, sothat they have no edges that can tear nearby tissue, except wheninserted, tip first. Such forming may be, for example, byelectro-polishing.

While the above clips have been described in general for any type ofblood vessel, it should be appreciated that particular modifications maybe desired for certain vessel types. For example, the aorta is thicker,while a coronary vessel is thinner, thus suggesting different amounts ofspace in the clip. For example, an aorta may be 3 mm thick, while acoronary vessel may be less than 1 mm thick.

In an exemplary embodiment of the invention, clip 100 is between 0.17 mmand 0.2 mm thick, is 0.4 mm wide on its body and 0.8 mm wide at its baseand curves in a radius of 0.8 mm. With reference to FIG. 4, a spacebetween the hook section and the medallion after locking can be, forexample, 0.25 mm. The hook can be, for example, between 0.15 and 0.17 mmthick and between 0.29 and 0.35 mm wide. The medallion can be, forexample, 0.4 mm thick with an area about 0.8 mm by 0.6 mm. These sizesare only exemplary and are intended to give a measure of the size of theelements involved. Each such dimension can be, for example, twice aslarge or half the size, depending on the particular application

It should be noted that the term “connector” should be construed broadlyto include various types of connectors, including one part, two part andmultiple part connectors, some of which when deployed, result in aplurality of individual clip-like sections.

The term “eversion”, where used means not only complete eversion of 180degrees, but also partial eversion or flaring, for example of 90degrees. Also, in some embodiments, mounting without eversion isprovided.

Measurements are provided to serve only as exemplary measurements forparticular cases. The exact measurements stated in the text may varydepending on the application, the type of vessel (e.g., artery, vein,xenograft, synthetic graft), size of connector, shape of hole (e.g.,incision, round) and/or sizes of vessels involved (e.g., 1 mm, 2 mm, 3mm, 5 mm, aorta sized).

In some embodiments, one or more of the devices, generally sterilize,described above, are packaged and/or sold with an instruction leaflet,describing the device dimensions and/or situations for which the deviceshould be applied. Also within the scope of the invention are surgicalkits comprising sets of medical devices suitable for making anastomoticconnections.

It should be appreciated that the above may be varied and still fallwithin the scope of the invention, for example, by changing the order ofsteps or by providing embodiments which include features from severaldescribed embodiments or by omitting features described herein. Sectionheadings where are provided are intended for aiding navigation andshould not be construed to limiting the description to the headings.

When used in the following claims, the terms “comprises”, “comprising”,“includes”, “including” or the like means “including but not limitedto”.

It will be appreciated by a person skilled in the art that the presentinvention is not limited by what has thus far been described. Rather,the scope of the present invention is limited only by the followingclaims.

1. A self-locking clip adapted for vascular tissue connection,comprising: a body; a sharp extension on one side of the body adapted topierce blood vessel tissue; and a base on another side of said body,said base adapted to interlock with said extension, at least to preventretraction of said extension from said base after inserted, wherein saidclip is pre-disposed to assume a closed configuration where said baselocks to said extension.
 2. A clip according to claim 1, wherein saidextension defines a plurality of locking positions.
 3. A clip accordingto claim 1, wherein said base defines an aperture adapted to receivesaid extension.
 4. A clip according to claim 3, wherein said aperture isadapted to guide said extension to be locked.
 5. A clip according toclaim 1, wherein said clip is adapted to be used as part of a set of aplurality of clips to complete single anastomosis connection.
 6. A clipdelivery system, comprising: a plurality of clips adapted for vasculartissue connection, each clip comprising: a body; a sharp extension oneither end of said body, wherein said clip is pre-disposed to form a “C”shape; an inner tube defining a plurality of slots; and an outer tubeaxially movable with respect to said inner tube, wherein said inner andouter tube define a receptacle for said clip, said clip being releasedwhen said outer tube is retracted relative to said inner tube andwherein said inner tube defines a slot adjacent said receptacle, saidslot adapted to receive a bent-back section of a backwards pointing oneof said extensions.
 7. A delivery system according to claim 6, whereinsaid body defines an aperture and wherein said inner tube defines amatching protrusion to said aperture and wherein said body curves whenreleased, such that said aperture is released from said protrusion.
 8. Aconnector clip adapted for vascular tissue connection, comprising: ahooked element comprising: an elongate body; a designated tear locationstructurally defined at a location along said body; a hooked tip adaptedto pierce a blood vessel; and a base element adapted to lock to saidhooked element, wherein said hooked element is adapted to not tearvascular tissue.
 9. A clip according to claim 8, wherein said hooked tipis adapted to not cut vascular tissue.
 10. A clip according to claim 8,wherein said hooked tip has the shape of a needle.
 11. A clip accordingto claim 8, wherein said hooked tip is manufactured by cutting andsmoothing a planar material.
 12. A connector clip adapted for vasculartissue connection, comprising: a hooked element comprising: an elongatebody; a designated tear location structurally defined at a locationalong said body; a designated locking location structurally defined at alocation along said body; a hooked tip adapted to pierce a blood vessel;and a base element adapted to lock to said hooked element at saidlocking location, wherein said designated tearing location is configuredto enhance a locking at said locking location.
 13. A clip according toclaim 12, wherein said tearing location is configured so that tearingcauses the bending of at least one part of said hooked element to narrowa passage of a portion of said base element within said hooked element.14. A clip according to claim 12, wherein said tearing location isconfigured so that tearing causes the bending of at least one part ofsaid hooked element to widen a portion of said hooked element whichtravels within said base element.
 15. A clip according to claim 12,wherein said tip is adapted to pierce vascular tissue without causingtearing.
 16. A connector clip adapted for vascular tissue connection,comprising: a hooked element comprising: an elongate body having a slotdefined therein; a designated tear location structurally defined at alocation along said body; a designated locking location structurallydefined at a location along said body; a hooked tip adapted to pierce ablood vessel; and a base element adapted to lock to said hooked elementat said locking location and including a section that fits in said slot,wherein said designated locking location is located in said slot.
 17. Aclip according to claim 16, wherein said hooked element comprises asecond designated locking location on an outside of said hooked element.18. A clip according to claim 16, wherein said tip is adapted to piercevascular tissue without causing tearing.
 19. A clip according to claim16, wherein said base element is planar.
 20. A connector clip adaptedfor vascular tissue connection, comprising: a hooked element comprising:an elongate body; a designated tear location structurally defined at alocation along said body; a designated locking location structurallydefined at a location along said body; a hooked tip adapted to pierce ablood vessel; and a base element adapted to lock to said hooked elementat said locking location, wherein said designated locking location isdefined by at least one active portion on said hooked element whichengages a portion of said base section.
 21. A connector according toclaim 20, wherein said base element includes no portions that moverelative to a center of gravity of said base element during a lockingactivity.
 22. A connector according to claim 20, wherein said baseelement is planar.
 23. A clip according to claim 20, wherein said tip isadapted to pierce vascular tissue without causing tearing.
 24. Aconnector clip adapted for vascular tissue connection, comprising: ahooked element comprising: an elongate body; a designated tear locationstructurally defined at a location along said body; a designated lockinglocation structurally defined at a location along said body; a hookedtip adapted to pierce a blood vessel; and a base element defining asecond locking location adapted to lock to said hooked element, whereinboth said base element and hooked element each include at least oneportion that moves during locking.
 25. A connector clip adapted forvascular tissue connection, comprising: a hooked element comprising: anelongate body having an axis; a designated locking location structurallydefined at a location along said body; a hooked tip adapted to pierce ablood vessel; and a base element having an aperture adapted to ride onsaid body, said base element adapted to lock to said hooked element atsaid designated locking location, wherein said locking locationcomprises at least one widening on said hooked element perpendicular tosaid axis and at least one aperture formed in said body adjacent saidwidening.
 26. A connector clip adapted for vascular tissue connection,comprising: a hooked element comprising: an elongate body having anaxis; a hooked tip adapted to pierce a blood vessel; and a base elementhaving an aperture adapted to ride on said body and wherein at least onesection of said base element contacting said aperture is adapted to beelastically moved to widen said aperture and comprising: at least oneholder adapted to widen said aperture when pulled against a resistanceof said hooked element in said aperture.
 27. A connector according toclaim 26, wherein said holder comprises an apertured holder.
 28. Aconnector according to claim 27, wherein said aperture contains athread.
 29. A connector according to claim 26, wherein said holder isadapted to be torn off said base element.
 30. A method of mounting abase element of an anastomotic clip on a hooked element of ananastomotic clip, comprising: placing said hooked element in an apertureof said base element; and pulling on a holder section of said baseelement to widen said aperture.
 31. A method of demounting a baseelement of an anastomotic clip on a hooked element of an anastomoticclip, comprising: pulling on a holder section of said base element towiden an aperture of said base element on which said hooked element ismounted; and removing said base element.
 32. A connector clip setadapted for performing a vascular anastomotic connection, comprising: aplurality of connector clips, each comprising: a hooked elementcomprising: an elongate body having an axis, a first end and a secondend; a pulling point adapted to have a pulling force applied to at saidfirst end a hooked tip adapted to pierce a blood vessel at said secondend a resting point for a base element between said ends; and a baseelement adapted to ride on said body and stop at said resting point,wherein a distance between said resting point and said pulling point isdifferent for different ones of said clips.
 33. A connector according toclaim 32, wherein said resting point is adapted to withstand a force ofat least 1 Kg applied from said pulling point.
 34. A pulling connectoradapted for vascular tissue connection, comprising: a ring; and aplurality of hooked elements, extending from the ring, having anelongate body curved into said ring, wherein said elongate elements arepre-disposed to retract such that they pull vascular tissue towards saidring to complete an anastomotic connection.
 35. A connector according toclaim 34, wherein said hooked elements rotate when released.
 36. Aconnector according to claim 34, wherein said curves flatten whenreleased.
 37. A connector according to claim 34, wherein said hookedelements are adapted to pierce blood vessel tissue without tearing. 38.A connector according to claim 34, wherein said ring defines a pluralityof recesses for said hooked elements.
 39. A connector according to claim34, wherein said ring is substantially rigid.
 40. A method of deployinga tearing vascular anastomotic connector having multiple tearing points,comprising: tearing a first leg to complete a first part of ananastomosis; and tearing a second leg after said first tearing tocomplete a second part of said anastomosis.
 41. A method according toclaim 40, comprising applying a continuous force to said connectorduring said first and second tearing and in between.